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Daryl Efron

Publications and source records attributed to Daryl Efron.

7 recordsLinked to original sources
PubMed2006

Attention-deficit/hyperactivity disorder: are we medicating for social disadvantage? (Against).

The functional impairments seen in attention deficit hyperactivity disorder (ADHD) are the result of a complex interplay between biological vulnerability and environmental influences. In children with ADHD from social disadvantaged families the latter often appear to predominate. Stimulant medication is the intervention with the largest demonstrable effect size in decreasing the core symptoms of ADHD, irrespective of social context. However, medication alone will not effectively treat common comorbidities, such as oppositional behaviour, anxiety, or learning disabilities. Nor can medication be expected to diminish major family discord or psychosocial adversity. Stimulant medication is one key therapy modality in children with ADHD. Data on prescribing rates do not support the assertion that there is systematic overprescribing of stimulants in Australia. There is, however, a serious problem with access to family support and appropriate services in schools for children with ADHD. Paediatricians have a responsibility to provide evidence-based medical treatment for children with ADHD (i.e. stimulant medication), while advocating across sectors for services to enhance family resilience and function.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Developmental assessment of children: a survey of Australian and New Zealand paediatricians.

OBJECTIVES: To determine the current practice for developmental assessment of children by Australian and New Zealand paediatricians. To determine factors associated with higher levels of self-reported confidence and expertise in developmental paediatrics and factors associated with better practice. METHODS: A cross-sectional postal survey of Australian and New Zealand paediatricians conducted in 2003, enquiring about their training in developmental paediatrics and their practice for evaluating development. RESULTS: Of 811 questionnaires sent, 590 (73%) were returned. Ninety-one respondents indicated that they did not see children with developmental issues leaving 499 surveys for analysis. The overwhelming majority of paediatricians felt that more training was required in developmental paediatrics (88%) and that there was a need to be taught a formal developmental assessment tool (83%). Higher self-ratings of confidence and expertise in developmental paediatrics were associated with a period of formal developmental training (OR (95% CI) 2.7 (1.6-4.4), 3.4 (2.0-5.8), respectively), and being taught a formal developmental assessment tool (OR (95% CI) 2.0 (1.2-3.2), 2.2 (1.3-3.7), respectively). Predictors of paediatricians performing a formal developmental assessment included formal developmental training (OR (95% CI) 2.0 (1.1-3.8)) being taught an assessment tool (OR (95% CI) 2.8 (1.5-5.2)) and mandatory training (OR (95% CI) 2.4 (1.4-4.1)). CONCLUSIONS: Developmental paediatrics is a significant and important part of paediatric practice. This survey suggests, however, that paediatric training and continuing education should have not reflected this practice. The overall method and content of developmental training including whether formal assessment tools should be taught needs to be reviewed and revised.

Australia↗
PubMed2005

Developmental delay--identification and management.

BACKGROUND: Developmental delay occurs in up to 5% of children under 5 years of age. This includes delays in speech and language development, motor development, social-emotional development, and cognitive development. General practitioners are in an ideal position to play a central role in the early detection of developmental and behavioural problems in young children. OBJECTIVE: This article discusses the advantages and disadvantages of various methods health professionals use to assess children's development. It recommends ongoing developmental surveillance (rather than point-in-time assessment) and a multidisciplinary approach. DISCUSSION: In a busy general practice, obtaining parent reports of development is a good "first line screen", and an efficient and effective way of selecting out children who require a more detailed assessment and/or referral. Early intervention is essential for optimising developmental progress in the delayed child.

Child Development↗
PubMed2003

Cerebral injury in association with profound iatrogenic hyperglycemia in a neonate.

The adverse effect of hyperglycemia on neurological outcome following cerebral ischemia has been established in both experimental and adult human studies. However, there is a paucity of data to assess this risk in the human infant. This case is the first to describe severe and prolonged iatrogenic hyperglycemia in association with ischemia in an infant who sustained a major cerebral lesion. The topography of the predominant cerebral injury, i.e., bilateral parieto-occipital cortex and subcortical white matter, shown by magnetic resonance imaging was similar to that documented in the hypoglycemic infant, suggesting a similarity in regional cerebral vulnerability to altered glucose metabolism. This case extends recognition of the risk of severe hyperglycemia in association with cerebral ischemia to the newborn and suggests also that the posterior cerebral predilection for injury is similar in both hypoglycemia and hyperglycemia.

Atrophy↗
PubMed2003

Prescribing of psychotropic medications for children by Australian pediatricians and child psychiatrists.

OBJECTIVE: To describe the pattern of prescribing of psychotropic medications for Australian children. DESIGN: Australia-wide cross-sectional postal survey conducted in 2000. PARTICIPANTS: All registered general pediatricians and child and adolescent psychiatrists. RESULTS: The survey was completed by 435 general pediatricians and 187 child and adolescent psychiatrists (response rates 72% and 70%, respectively). Stimulants and clonidine were the most frequently prescribed medications. Seventy-two percent of practitioners reported that they had prescribed a combination of medications. Frequent combinations included a stimulant and clonidine (64% of pediatricians, 51% of child psychiatrists) and a stimulant and a selective serotonin reuptake inhibitor (SSRI; 29% of pediatricians, 36% of child psychiatrists). Pediatricians were more likely than child psychiatrists to report prescribing clonidine for sleep problems (67% vs 36%). Child psychiatrists were more likely than pediatricians to report prescribing SSRIs (93% vs 75%) and mood stabilizers (45% vs 11%) for depression, and SSRIs (74% vs 50%) and tricyclic antidepressants (37% vs 12%) for obsessive compulsive disorder. Off-label prescribing (indication or age not included in the product information) was reported by 40%. Over 5% of practitioners in this study had prescribed clonidine, methylphenidate, dexamphetamine, and typical neuroleptics for children under 3 years of age. CONCLUSIONS: A broad range of psychotropic medications are being prescribed for Australian children, with some medication groups being prescribed frequently. Combinations of psychotropic medications are used regularly, and there is some prescribing for very young children. The safety and efficacy of several of the agents prescribed have not been adequately researched in children. There is an urgent need for pediatric psychopharmacology research to inform current prescribing practice.

Adult↗
PubMedDate not supplied

Early case conferences shorten length of stay in children admitted to hospital with suspected child abuse.

OBJECTIVE: To compare the outcomes of two models for the management of children admitted to hospital with suspected child abuse: routine early case conferencing versus standard evaluation. METHODS: Between March 2001 and February 2002 professionals from the Royal Children's Hospital, Melbourne, Victoria Police and Child Protection services collaborated on a randomized controlled study involving children admitted to hospital with suspected child abuse. The intervention group (n = 13) received a case conference within 24 h of the child's admission to hospital. The control group (n = 12) were managed according to standard procedures whereby each organization conducted their own evaluation (and a case conference might or might not have been held). Patients were followed for 3 months with data collected from all three professional groups. RESULTS: The process of evaluation, the eventual diagnosis of child abuse and the confidence with which professionals made this diagnosis was not significantly different between the groups. Case conferences were judged to be useful regardless of their timing. Mean length of stay in the intervention group was significantly less than in controls (42.4 h vs 99.7 h, P = 0.01). CONCLUSION: Early case conferences appear to shorten the period of time children spend in hospital when child abuse is suspected. This has significant implications for reducing costs for all organizations involved in the evaluation of suspected child abuse.

Adolescent↗